Infections in Heart-Lung Transplant Recipients

Js, Dummer; Cg, Montero; Bp, Griffith; Rl, Hardesty; Il, Paradis; M, Ho

doi:10.1097/00007890-198606000-00012

Cited by 155 publications

(73 citation statements)

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“…The PCP incidence in cancer patients without PCP prophylaxis varies by diagnosis (e.g., 22 to 45% for lymphomas and 25% for rhabdomyosarcomas) (125,264). Hematopoietic stem cell transplantation and solid organ transplantation also increases the risk of PCP, and these patients are generally offered PCP prophylaxis (72,75,106,325). Patients with collagen vascular disease have an elevated risk for PCP, particularly those with Wegener's granulomatosis (103,235).…”

Section: Recent Epidemiology Of Pcp In Non-hiv-infected Immunosuppresmentioning

confidence: 99%

Colonization by Pneumocystis jirovecii and Its Role in Disease

2012

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SUMMARY Although the incidence of Pneumocystis pneumonia (PCP) has decreased since the introduction of combination antiretroviral therapy, it remains an important cause of disease in both HIV-infected and non-HIV-infected immunosuppressed populations. The epidemiology of PCP has shifted over the course of the HIV epidemic both from changes in HIV and PCP treatment and prevention and from changes in critical care medicine. Although less common in non-HIV-infected immunosuppressed patients, PCP is now more frequently seen due to the increasing numbers of organ transplants and development of novel immunotherapies. New diagnostic and treatment modalities are under investigation. The immune response is critical in preventing this disease but also results in lung damage, and future work may offer potential areas for vaccine development or immunomodulatory therapy. Colonization with Pneumocystis is an area of increasing clinical and research interest and may be important in development of lung diseases such as chronic obstructive pulmonary disease. In this review, we discuss current clinical and research topics in the study of Pneumocystis and highlight areas for future research.

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Section: Recent Epidemiology Of Pcp In Non-hiv-infected Immunosuppresmentioning

confidence: 99%

Colonization by Pneumocystis jirovecii and Its Role in Disease

2012

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“…However, the most commonly isolated pathogens after lung transplantation are bacteria, broadly separated into gram-negative and gram-positive organisms (5)(6)(7)(8). The gram-negative Pseudomonas aeruginosa is the most frequently isolated bacterium after lung transplantation (5)(6)(7)(9)(10)(11)(12). Moreover, bacterial pulmonary infections have been associated with increased bronchoalveolar lavage fluid (BALF) levels of inflammatory markers, including the glutamic acid-leucine-arginine-positive (ELR 1 ) CXC chemokine IL-8 (CXCL8) (13)(14)(15)(16).…”

mentioning

confidence: 99%

Interaction between Pseudomonas and CXC Chemokines Increases Risk of Bronchiolitis Obliterans Syndrome and Death in Lung Transplantation

Gregson

Wang

Weigt

et al. 2013

Am J Respir Crit Care Med

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Rationale: Pseudomonas aeruginosa is the most commonly isolated gram-negative bacterium after lung transplantation and has been shown to up-regulate glutamic acid-leucine-arginine-positive (ELR 1 ) CXC chemokines associated with bronchiolitis obliterans syndrome (BOS), but the effect of pseudomonas on BOS and death has not been well defined. Objectives: To determine if the influence of pseudomonas isolation and ELR 1 CXC chemokines on the subsequent development of BOS and the occurrence of death is time dependent. Methods: A three-state model was developed to assess the likelihood of transitioning from lung transplant (state 1) to BOS (state 2), from transplant (state 1) to death (state 3), and from BOS (state 2) to death (state 3). This Cox semi-Markovian approach determines state survival rates and cause-specific hazards for movement from one state to another. Measurements and Main Results: The likelihood of transition from transplant to BOS was increased by acute rejection, CXCL5, and the interaction between pseudomonas and CXCL1. The pseudomonas effect in this transition was due to infection rather than colonization. Movement from transplant to death was facilitated by pseudomonas infection and single lung transplant. Transition from BOS to death was affected by the length of time in state 1 and by the interactions between any pseudomonas isolation and CXCL5 and aspergillus, either independently or in combination. Conclusions: Our model demonstrates that common post-transplantation events drive movement from one post-transplantation state to another and influence outcomes differently depending upon when after transplantation they occur. Pseudomonas and the ELR 1 CXC chemokines may interact to negatively influence lung transplant outcomes.Keywords: transplantation; lung; BOS; pseudomonas; chemokine Lung transplantation is a life-saving procedure for end-stage lung disease. Long-term success is limited by the high incidence of chronic lung allograft dysfunction, predominantly due to bronchiolitis obliterans syndrome (BOS). Acute rejection is perhaps the most widely recognized event to increase the risk of chronic lung allograft dysfunction. There is expanding evidence that a variety of infections increase the chances of developing BOS. Fungal pneumonia or colonization (1, 2) and viral pneumonitis (1, 3, 4) are among infectious conditions shown to increase the risk of BOS. However, the most commonly isolated pathogens after lung transplantation are bacteria, broadly separated into gram-negative and gram-positive organisms (5-8). The gram-negative Pseudomonas aeruginosa is the most frequently isolated bacterium after lung transplantation (5-7, 9-12). Moreover, bacterial pulmonary infections have been associated with increased bronchoalveolar lavage fluid (BALF) levels of inflammatory markers, including the glutamic acid-leucine-arginine-positive (ELR 1 ) CXC chemokine IL-8 (CXCL8) (13-16). Prior studies have suggested that pseudomonas may influence the development of BOS by de novo colonization after lung transp...

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“…However, it is thought that most cases of P. jiroveci pneumonia develop following acquisition of a new stain shortly before clinical symptoms manifest [46]. Particular attention was given to P. jiroveci infection in SOT recipients in the 1980's given to high rates of infection in heart-lung transplant recipients [47,48]. However, in the era of routine prophylaxis for at least 6 months following the transplant procedure in all solid organ groups [41], Pneumocystis infections in the SOT population are rare.…”

Section: Pneumocystis Jirovecimentioning

confidence: 99%